HomeMy WebLinkAbout401 S SummerlinCEIV
CITY OF SANFORD
BUILDING=8t FIRE- PREVENTION
IAN 13 2016 PERMIT APPLICATION
Application No:
Documented- Construction Value: S 111102'"
Job Address: 440/ J j(,f1fi/IQ 1.11140 Historic District: Yes No
Parcel ID:,S&4'/y',Rl : Sts d d ca" o-17,(% Residential Commercial
Type of Work: New Additio/n I ldAlteration ' Rempair Deo . Change of Use El moveve E]
Description of Work: e/TG I.,f,, /, 11,11 !0 /-/,0,n6-8/7 16-041
ea -a h§ 6GEt Bf `jd0.:o Inn SAIJ.1 ft
Plan Review Contact Person: , , C& yh dtTitle: 69e
Phone: f'5 -,/ ,5-l`'73 0%/ Fax: Email:_A&y/i10A,"C /, cJA,
Property Owner Information
Name &'-/n an 6 6 / CA 605, Phone:
Street: 4/,#/ r"'l ' Resident of property? : f
City, State Zip: _
4 11_
Name
Cdntraeter Mfditati6n
Fax: 4/d i F,S7 d4//s
State License No.: eic-Cv d S7 36'5 -
Street: -
City, State Zip:
Name:
Street:
City, St, Zip:
6 ZF3
Architect/Engineer Information
Phone:
Fax:
Email:
Bonding Company: Mortgage Lender:
Address: Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction
in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
FRC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 51 Edition (2014) Florida Building Code
Revised June 30, 2015 Permit Application
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be
found in the public records of this county, and there maybe additional permits required from other governmental entities such as water
management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
OWNEWS
AFEIDAVITi:
Y certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning.
Z1
Signature of Owner/Agent Date
A)jc a,7
Print owner/Agent's Name
tgnature of Notary -State of Florida Date
ignature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of No -S tate,o,o l",,o„ "
Harp
KARVIE MAH AD AMS
MY COMMIS. NSIAYPV --• =*: ;0 ff EE 139929
KARWESMA,y pDAPAS '+ `W= EXPIRES: Ap6116, 2016
MY COMMrSS; '` Bonded Thru Naiar P0ft," r! EE 199929 f > Public Underwriters
a;
b EXi !RES• Apn; 16, 2016BondedThru ;; pi,blit Jadcnypters
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Owner/Agent is Personally Known o - ontractor/Agent is PlooPersonally Known to Me or
Produced ID Type of ID Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Tin. Occupancy Load:
New Construction: Electric - # of Amps.
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
CO1MENTS:
UTILITIES:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
LIMITED POWER OF ATTORNEY
Date:
I hereby name and appoint /- - ! to be my lawful attorney in
fact to act for me and apply for a —
7g2 AIAAIApermit for work to be
performed at the location described as:
zed l , Scr• ./,
Address of Job)
Aftlkofl? 11,1/i 64
Owner of Property)
And to 'gn my name and do all things necessary to this appointment.
Signature ofified C actor)
dd 66al-'C'
Printed Name of Contractor and License Number)
STATE OF FLORIDA COUNTY OF L /;&
7 V
The foregoing instrument was acknowledged before me this/2---day of U , 20 y
by , who is ersonally known to me or has produced
take an oath.
Signature of Notary Public, State of Florida
Prin ype/Stamp Name of Notary Public
October 2009
type of identification) as identification and who did
SEAL)
KARWEEMAHADAMS aMYOA4MISSIONdEE189929
tpnl 16, 2016
ary Public Underwriters
This instrument prepared by: MARYANNE MORSEP SEMINOLE COUNTY
Name:C / .r CLERK OF CIRCUIT COURT & COMPTROLLER
Cj .F-7 BK 8615 Ps 697 (Wss ) SAddress: .( 6 04( d' CLERK'S Y 2016004.4.12
RECORDED 01/13/2016 02:07:28 PN
NOTICE OF COMMENCEMENT RECORDING FEES $10.00
RECORDED BY :iackenro
STATE OF FLORIDA Permit #:
COUNTY OF SEMINOLE PARCEL ID #:%-10 661' V — d7? 0
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property; and in
accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1 Description of Property: (Legal description of the property and street address if available) 4 7 S 1 -0- 7P
f lu',,
JJ
v'
1j
2 General Description of Improvements: W1 a ,•j'7e?,-0 /19.0 40 6
X11?
74- J
3 Owner Name: (;;, 16i,,q / Phone:
Address: 41 -dl Jy qAAW1111 IV,
Interest in property: &6.AA.).2 r'
Name & Address of fee simple titleholder: (if other than owner) A
4 Contractor's Name: 4b !''d 6'l ,[/ Phone:
9
Address:
5 Surety Name: Phone:
Address: Amount of Bond: $
6 Lender Name: Phone:
leiAddress:
7 Persons within the State of Florida designated by Owner upon who notice or other documents may be served as provided by Section
713.13(1)(a) 7. Florida Statues: Name: Phone:
Address:
8 In addition to himself or herself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes: Name: Phone:
Address:
9 Expiration Date of Notice of Commencement:
the expiration date is 1 year from date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE
BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Verification Pursuant to Section 92.525, Florida Statutes
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief.
Signa re of Owner or Owner's Authorized Signatory's Title/Office
Officer / Director / Partner / Manager f
The foregoing instrument was acknowledged before me this day of c G' 20 I , by
name of person) as (type of authority, ...e.g. officer, trustee, attorney in fact) for
name of party on behalf of whom instrument was executed).
SEAL)
Signature of Notary Public, State of Flo ida
4lbeettt c,td C41 h'J
CERTIFIED COPY–MARYANNE MORSE
CLERK OF THE CIRCUIT COURT AND N .
COMPTROLLER 4r y •. ;.oe.
SEMINOLE COUNTY, FLORIDA rl r 0,i
BYU--D - _DEPUTYCLERS
September 2014 10
Print, Type or Stamp Commissioned Name of Notary Public
Personally Known or Produced Identification
KAS:''RBIAHARMIS _
N C05d x:c c;CN # EF. 1-59929
EXPIRF .W1 I6, 2016
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